Care Certificate Workbook Duty of Care 3
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Care Certificate Workbook
Duty of Care
3
Care Certificate Workbook
Duty of Care
2
Contents
Understand how duty of care contributes to safe practice
a) Define ‘duty of care’
b) Describe how duty of care affects your own work role
Understand the support available for addressing dilemmas that may arise about duty of care
a) Describe the dilemmas that may arise between the duty of care and an individual’s rights
b) Explain what you must and must not do within your role in managing conflicts and dilemmas
c) Explain where to get additional support and advice about how to resolve such dilemmas
Deal with comments and complaints
a) Demonstrate how to respond to comments and complaints in line with legislation and agreed ways of working
b) Describe who to ask for advice and support in handling comments and complaints
c) Explain the importance of learning from comments and complaints to improve the quality of service
3
3.1
3.2
3.3
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Deal with incidents, errors and near misses
a) Describe how to recognise adverse events, incidents, errors and near misses
b) Explain what you must and must not do in relation to adverse
events, incidents, errors and near misses
c) List the legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors or near misses
Deal with confrontation and difficult situations
a) List the factors and difficult situations that may cause
confrontation
b) Describe how communication can be used to solve problems and reduce the likelihood or impact of confrontation
c) Describe how to assess and reduce risks in confrontational
situations
d) Demonstrate how and when to access support and advice about resolving conflicts
e) Explain the agreed ways of working for reporting any
confrontations
3.4
3.5
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How to use this workbook
Do you need this workbook?
You need to do all 15 Care Certificate Standards. This workbook is designed to
support you to learn about Standard 3. Your manager is responsible for checking
your knowledge, understanding and competence in your specific workplace(s).
If you already have a good level of knowledge and experience, you could take
an assessment instead and only do sections of the workbook (or sections of our
eLearning) that you need to. Your knowledge would be recorded and you can
build an evidence portfolio. This will save you and your manager a lot of time.
Your organisation may have free or funded access to our assessment system.
Check with your manager before you start this workbook. More information can
be found at www.CareCertificate.co.uk.
The following symbols refer to actions you should take to achieve the outcomes.
There is also an action checklist at the end of this workbook.
Reference “Manager”
We refer to “manager” through the workbook. This may mean something
different in your role, for example: supervisor, line manager, coach, buddy,
mentor, employer or assessor. This is the person responsible for checking you
are competent and confident to work.
3
Ask…
LOCATE
DISCUSS
THINK
DEMONSTRATE
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Understand how duty of care contributes to safe practice
3.1
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Define ‘Duty of Care’
3.1a
Duty of Care
Everyone has what is known as a ‘Duty of Care’ towards
the individuals they support. This is a legal obligation
whereby you must do everything you can to keep the
individuals in your care safe from harm. Your employer
also has a duty of care to provide working conditions that
are safe for you to work in.
It involves acting in the individual’s best interests and in
the best interests of others. It is about working within your
competence and in line with your employers agreed
ways of working.
Duty of Care also involves working in line with legislation
to protect individuals from harm, abuse and neglect.
Whatever your role, you have a duty of care to all
individuals you support. It is not a choice and should be
the natural way in which you conduct yourself with
everyone you have contact with.
Definition
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Describe how duty of care affects your own work role
Your responsibilities under the duty of care include:
3.1b
SupportSupporting individuals to live in an environment that is free from prejudice
ReduceReducing the risk of harm, abuse and neglect
Consent
Gaining the consent of an individual if you are acting in their
best interests (unless you have evidence that the person lacks
capacity to make that particular decision at that particular
time, Mental Capacity Act 2005)
ProvideProviding care and support to meet the needs of the individuals
PromotePromoting individuals' wellbeing and independence
RespectInvolving and respecting the individual in any decision affecting their care and support
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In your role you have a duty of care to raise any concerns you may have about
any aspect of your work. These can range from inadequate working conditions,
poor equipment, poor practice by other staff; to raising concerns about
potential abuse cases and situations of neglect.
It is your duty of care to safeguard individuals from
harm and abuse. All employees should report any
concerns of abuse they have. These might include
evidence or suspicions of bad practice by colleagues
and/or managers, or abuse by another individual,
another worker, or an individual’s family or friends.
See Standard 10 for information on Safeguarding.
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A negligent act or act of omission that results in abuse or injury could be
unintentional, careless or intentional. A negligent act is breaching the
duty of care. If an individual has evidence that you have been negligent, you
are likely to be disciplined. You could lose your job and you could have legal
action taken against you. This also applies if you witness such an act and fail to
report it. If you are in any doubt at any time, you must discuss any issues you
have with your manager.
Discuss with your manager any
concerns you may have about your
duty of care
Ask…
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Understand the support available for addressing dilemmas that may arise about duty of care
3.2
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Describe the dilemmas that may arise between the duty of care and an individual’s rights
During your work you may find yourself in situations where the individuals you
are supporting do not agree with what you believe is best for them.
Who knows best? The individuals you support, you, another health
and social care worker, or the family?
3.2a
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In situations where there is a
conflict of interest or a dilemma
between your duty of care and
an individual’s rights, it is best
practice to make sure the
individual is aware of the
consequences of their choice
and that they have the mental capacity to understand the risks involved in
their choice. It is their right as an individual to be able to make informed choices
about their own lives even if you disagree with their choice.
It is the right of every individual receiving
support to make choices and take risks.
It is your role to assist them in making
those choices and reducing the risks
without compromising the individual’s
rights. An individual may be restricted if
their behaviour presents a serious risk of
harm to themselves or to other people
(including you).
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If an individual you support is considered to be at risk, the law requires that an
assessment be carried out to look at any possible risks there might be to the
individual or to others. The aim of this assessment is not to remove the
individual’s right to take risks, but to recognise and reduce them where
possible to an acceptable and manageable level.
Mental Capacity Act
Mental Capacity Act (MCA) 2005 has four steps to
determining capacity. Capacity means whether a
person is able to make informed decisions and choices.
See Standard 9 Outcome 6 for more information.
Note
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The term ‘a person who lacks capacity’ means a person who is unable to
make a particular decision or take a particular action for themselves at the time
the decision or action needs to be taken.
Individuals who could lack capacity include:
Stroke victims
Dementia sufferers
Individuals who have an acquired brain injury (trauma)
Individuals with learning disabilities
Substance misusers
It is important you are familiar with the
Mental Capacity Act (MCA). You may be
concerned that an individual you are
working with shows signs of lacking the
capacity to make decisions for
themselves. This could happen to an
individual at any time and you will need
to ask for professional support to assess
if the individual does lack capacity.
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Explain what you must and must not do within your role in managing conflicts and dilemmas
If individuals insist on doing something that you think is risky, you can only
advise them and encourage them to make an informed decision. You cannot
force them to do (or not do) anything.
3.2b
If an individual refuses to take
medication and their wellbeing
depends on this medication, you
cannot force them to take the
medication.
You should immediately contact
your manager or the prescriber
(usually the GP) and ask for advice.
You should also make sure you
record what has happened and the
action taken in the support plan.
Example
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A physically disabled individual you are working
with asks you to support him to go to a café every
day so he can eat burger and chips, which is his
favourite food.
You believe that burgers are unhealthy and
shouldn’t be eaten that regularly. The individual
has the mental capacity to make this kind of
decision.
Which of the following should you do?
1. Refuse to take the individual to the restaurant and insist they go somewhere else.
2. Accept it is the individual’s choice and support them to go to the restaurant.
3. Engage the individual in a conversation about healthy food and ask them if they would like to try somewhere different. Then support them to go to the fast food burger restaurant if this remains their choice.
Scenario
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You should help the individual to
understand the health risks of eating burger
and chips every day. Help them to
understand the importance of a balanced
diet and ask if they would like to try
something different for a change. Then
support them with their choice, even if it
remains the same.
This allows the individual to make an
informed choice about where and what
they eat. Use an encouraging and
supportive tone of voice and words that do
not make the individual feel bullied or
harassed into doing something that you
think they should do.
Don’t forget to consider whether the
individual has the capacity to make
decisions. Your manager is there if you
need additional advice and support to
manage conflicts and dilemmas.
Scenario Answer
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Explain where to get additional support and advice about how to resolve such dilemmas
You should know the limits of your role and not do or say anything outside of this.
3.2c
PERSONAL PROFESSIONAL
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It is important that you know where to go if you need additional support and
advice about how to resolve dilemmas.
If you are in a situation that you are not comfortable with, contact your
manager. They will support you and help you resolve such dilemmas whilst still
maintaining your duty of care.
Resolution
esolution
Support Advice
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Other sources of additional support and advice include:
LiteratureOnline
resource Pages
Internet e-Learning
SupervisionTraining courses
Work Shadowing
Other Professionals
Individual's friends
Individual's family
Advocates Assessment
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Think about similar situations which
have happened to you when supporting
an individual
Discuss any outstanding issues or
concerns you may have with your
manager
Ask…
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Deal with comments and complaints
3.3
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Demonstrate how to respond to comments and complaints in line with legislation and agreed ways of working
Comments and complaints can be made by:
In fact, comments and complaints can be made by anyone who feels there is
something wrong that needs to be addressed in line with legislation and agreed
ways of working.
It is important to remember that the individuals you support may not know how
or may be reluctant to make comments or complaints. Some individuals will feel
uncomfortable about making complaints as they do not want to cause trouble
and they do not want to risk services being reduced or removed.
It is therefore important that you know what the
procedures are and can advise them what to do.
Every employer should have a complaints
procedure (usually part of the Policies and
Procedures Manual) in place that you can follow.
This will enable people to express their displeasure
of a service, person, situation etc. It is useful if the
procedure includes a flowchart of how a complaint
is dealt with so you can see and follow the process.
3.3a
Individuals Workers Carers Family
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Every complaint should…
Be taken seriously and dealt with promptly and fully
Be acknowledged within a specific time
Have time limits for preliminary investigation
Be monitored and progress reported to the complainant
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The Care Quality Commission (CQC)
provide details on how complaints
should be dealt with in their
‘Fundamental Standards
Regulations’.
The regulations state that
‘complaints must be appropriately
investigated and appropriate
action taken in response’ and
‘systems and processes must be
established to ensure compliance
with the fundamental standards’
CQC state this will happen
because providers who comply
with the regulations will:
• Have systems in place to deal with
comments and complaints including
providing people who use services with
information about that system
• Support people who use services or others
acting on their behalf to make comments
and complaints
• Consider fully, respond appropriately and
resolve, where possible, any comments
and complaints
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Describe who to ask for advice and support in handling comments and complaints
3.3b
Larger employers may have a comments and complaints specialist who
you can refer people to. In smaller organisations or if you work with an
individual in their own home, you may be responsible for dealing with
the complaint yourself.
Your employer should give you clear and precise information about your
role and responsibilities in dealing with complaints. If you are unsure,
ask your manager.
Some individuals may need an Independent Advocate to support
them to make a complaint and to support them until the complaint has
been dealt with or resolved. They will be able to give impartial advice,
help to write letters, attend meetings and make sure that the person
complaining’s views are heard, especially if the person has
communication difficulties.
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The Local Authority Social Services and NHS Complaints (England) Regulations 2009 is the legislation for complaints in health and social care.
If you receive positive comments about your service or any aspect
of the service your employer provides, it is important that you record
these comments and pass them on to your manager. If the individual
making the comment is able to write, it is worth asking them to put
the comment in writing or you might be able to help them to do this.
Positive comments are motivating and supportive so people know
they are doing things right.
Independent Advocates can usually be provided by voluntary
organisations. If you use a search engine on the internet and type in
‘Independent Advocates’ you will find lots of different organisations
providing advocacy services. Advocates may specialise in Mental
Health or Mental Capacity.
It would also be worth finding out what organisations can provide
Independent Advocates locally.
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Check Understanding
Feedback from the people we support
and Observe Practice
Assess Knowledge
Explain the importance of learning from comments and complaints to improve the quality of service
Comments and complaints are really important
because they enable you to learn how people
perceive the support and service you provide. This
enables you to make improvements to the
overall quality which leads to better
outcomes for the individuals you work with.
Learning from complaints can be something that is discussed in supervision.
Your employer might ask the
individuals you support for
feedback about the quality of
the support and services they
receive, or you might
participate in a 360 degree
feedback* about your own
performance.
You can use the responses to look at how well you are doing and what areas can
be improved upon. Whilst it might seem like a negative thing to receive a
complaint, if it is handled well, it can lead to great improvements and benefits
for everyone involved.
*www.Three60degree.co.uk is a performance feedback tool offered by The Grey Matter Group
3.3c
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Think about comments and complaints.
Did you respond in line with legislation
and agreed ways of working? What
have you learnt?
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Deal with incidents, errors and near misses
3.4
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Describe how to recognise adverse events, incidents, errors and near misses
3.4a
Incident
This is something that has happened, whether it is an
accident or not.
Accident
This is an unfortunate incident that happens
unexpectedly and unintentionally, which results in injury,
ill health or death.
Adverse Event
This is an accident or incident.
Error
A mistake.
Near Miss
A situation that has narrowly avoided becoming an
incident, accident or error.
Definitions
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Whilst working, it is important
that you can recognise incidents,
accidents, errors and near misses
likely to affect the wellbeing of
the individuals you support.
It is also important to recognise
near misses so that steps can be
put in place to ensure they do
not become incidents, errors or
accidents in the future.
Support plans should have formal risk assessments that will guide you.
However, circumstances can change every day and you will make judgments
about the risks of what you are doing before undertaking all tasks. Risks must
be identified before tasks are undertaken.
Support Plan
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Think about the four main areas you are working in:
What you have to do
The individual and their capability
The task that needs to be done
Your surroundings
You should always record any changes and contact
your manager or the person responsible for the
individual’s care and support plan if you feel a risk
assessment should be formally changed.
Note
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Explain what you must and must not do in relation to adverse events, incidents, errors and near misses
You should only take action and become involved in certain situations if you
have been appropriately trained, observed and signed off as competent. If you
are unsure it is important to seek help.
3.4b
Example
If you are the first person to attend an
incident where an individual may need
Emergency First Aid, you can only do what
you are safe and competent to do. You
should never go straight to the casualty
without making sure the area is safe. This is
called a primary survey.
Emergency First Aid
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Fire
If you discover a Fire, you should
immediately raise the alarm. You
should not tackle a fire with an
extinguisher unless you are safe and
competent to do so. You must not
put yourself or others in any danger. It
is essential that you leave the building
as quickly as you can supporting
others to leave where you can.
Example
It is essential to write down what happened
immediately after the event so you will be able to refer
to your notes about what happened rather than rely on
your memory which might not be accurate, particularly
if you felt stressed.
Note
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You should always reflect on situations to consider if you
could have handled things differently or behaved in a
different way. Would the outcome have been any better for
anyone involved? This gives you the opportunity to consider
your level of skill and your confidence, and whether you need
any further learning and development.
List the legislation and agreed ways of working in relation to reporting any adverse events, incidents, errors or near misses
Each piece of legislation in the list below provides guidance on how to help
maintain a safe workplace, and the agreed ways of working for reporting any
adverse events, incidents, errors or near misses.
The Health and Safety at Work etc. Act 1974
The Management of Health and Safety Regulations 1999
The Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations 2013 (RIDDOR)
The Control of Substances Hazardous to Health Regulations 2002
(COSHH)
The Provisions and Use of Work Equipment Regulations 1998 (PUWER)
Further information on each can be found: www.hse.gov.uk
3.4c
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Informing individuals of their options and the risks involved enables you to
support their empowerment and independence. If you witness anything
you feel is risky or unsafe, it is necessary to report your concerns to your
manager.
It takes a great deal of courage for an
individual to raise concerns about poor
practice or abuse in their organisation. It
is your duty of care to report anything that
is likely to affect the wellbeing of the
individuals you support.
If you have suspicions or evidence
that an individual or individuals
might be being abused, you have a
duty to report this. The Public
Interest Disclosure Act 1998
and the Whistle-blowers
Charter protects employees from
victimisation if they should need
to report abuse or neglect.
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Whistleblowing
Your organisation MUST have a ‘Whistleblowing’
policy. This will protect you and your employment if
you report your concerns. Whistleblowing is about
reporting incidents of suspected or actual abuse or
neglect.
If you have a concern and want to report an incident
or a suspicion, it is recommended that you read the
Whistleblowing policy. To ‘Blow the Whistle’ on a
wrong-doing means to report a person or persons for
doing something wrong, illegal or in contrary to the
agreed ways of working within an organisation.
The Fundamental Standards state that ‘individuals
must be protected from abuse and improper
treatment’ and it is your duty of care to report all
concerns are soon as possible. If your concerns are
not taken seriously, you must try another route. You
must ask for help if you feel ‘out of your depth’ with a
particular individual or issue.
Definition
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An approach of
‘Zero Tolerance’
must be taken to ensure that
adults at risk are protected,
and any adverse events,
incidents, errors and near
misses are reported.
Locate, list and read legislation and
agreed ways of working in relation to
reporting any adverse events,
incidents, errors and near misses
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Deal with confrontation and difficult situations
3.5
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List the factors and difficult situations that may cause confrontation
Most people do not like confrontation and may try to avoid difficult situations
and conversations. People often find it easier to avoid bringing up issues that
they think are going to be controversial or may cause confrontation, putting off
the communication and letting the situation fester.
Factors which may cause confrontation include:
A difference in…
…can also cause confrontation.
3.5a
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Many difficult situations may cause confrontation such as…
These examples can provoke confrontation in people who…
A change in routine
A death of a family member
New mobility equipment
Dislike of a new environment
Example
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Describe how communication can be used to solve problems and reduce the likelihood or impact of confrontation
By speaking up and dealing with a difficult situation or confrontation, you are more likely to reduce the impact they have and solve any issues.
3.5b
Different communication techniques and conflict management procedures can be used. For example:
Use comminication that is positive and constructive
Outline issues in full so each person involved is aware of all implications
Establish good rapport
Set a time frame for the discussion
Make sure you are in a suitable environment
Work to cool down the debate in a tense confrontation
Acknowledge emotions and different styles of expressing pain / upset / anger etc.
Use names and, if appropriate, titles throughout
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Also remember to recognise the importance of non-verbal communication
when dealing with emotional situations!
Impact of Confrontation
Upset
Feeling intimidated
Satisfaction
Physical injury
Personal dislike Disengage
from work
Teamwork breaks down
Resentment
Problem solving
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Describe how to assess and reduce risks in confrontational situations
It is important to recognise when a situation may escalate and responding
positively can help reduce the impact of the situation.
Once you have determined the level of
confrontation, you must adopt an appropriate
initial response as this can impact on the whole
outcome of the situation. Try to understand the
reasons why a situation is occurring. Be
observant to the wider picture.
3.5c
Assess the situation. Is it going to escalate? Is one
person threatening another? Is it going to turn
nasty or physical? Is it a healthy debate? Is each
party keen to meet and thrash things out?
If you are unable to calm the situation or you are
worried that it is going to get worse, you will
probably need someone else to help. Ask your
manager for advice and support.
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Here are some key points to help you assess and reduce the risks of
confrontational situations:
Identify
Identify early signs and take
action
Intervene
Intervene effectively in
the early stages
Demonstrate
Demonstrate an
understanding of the attitude and reason for
the confrontation
Recognise
Recognise the difference between
assertion and aggression
Research
Research ways to prevent escalation
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Demonstrate how and when to access support and advice about resolving conflicts
3.5d
After calming a difficult situation,
recognise the importance of providing exit
routes and space for everyone involved.
Many different emotions and reactions can
follow a difficult situation.
It is good practice to reflect on what has
happened and learn from it.
Create an environment or plan a
conversation where each person involved
can express their feelings and concerns and
where everyone feels equally listened to.
If it is a repeated situation, identify the
conditions and behaviours that trigger an
angry response in a person and what will
help them overcome this response.
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Explain the agreed ways of working for reporting any confrontations
Your manager should be able to support you to understand the agreed ways of
working for reporting any confrontation in your organisation. Ask your manager
where these can be found.
The confrontation should be recorded in the support plan and any actions taken
and consequences should also be logged. If a confrontation has resulted in
physical injury or assault, you may need to involve the police. This will depend
on the victim’s wishes and the extent of any injuries sustained.
It is important to resolve conflicts as soon as possible and reflecting and learning
from the experience(s) will help you develop in your role.
Conflict and confrontation mean different things to different people. A person’s
personality and style will impact how they respond to situations and
information. Some people enjoy a heated discussion whilst others find it
upsetting or intimidating. It is important to react and deal with any
confrontations as explained in your agreed ways of working.
3.5e
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Locate your organisations agreed
ways of working for reporting and
dealing with confrontation. The Care
Quality Commission (CQC) expect all
staff to know where these can be
found.
Think about whether you could have handled a situation better? What have you learnt?
Discuss situations with your colleagues
and manager. Talking things through
can help you overcome issues, feelings
and help you progress in your work
Ask…
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Your checklist….
Outcome Symbol Description Tick
3.1b Discuss with your manager any
concerns you may have about
your duty of care
Ask…
Think about similar situations which
may have happened to you when
supporting an individual
3.2c
Discuss any outstanding issues or
concerns you may have with your
manager
Demonstrate how to respond to
comments and complaints in line
with legislation and agreed ways of
working
3.3a
3.3c
Think about comments and
complaints. Did you respond in
line with legislation and agreed
ways of working? What have you
learnt?
Locate, list and read legislation
and agreed ways of working in
relation to reporting any adverse
events, incidents, errors and near
misses
3.4c
Ask…
Demonstrate how and when to
access support and advice about
resolving conflicts 3.5d
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Your checklist continued….
Outcome Symbol Description Tick
3.5e Locate your organisations agreed
ways of working for reporting and
dealing with confrontation. The
Care Quality Commission (CQC)
expect all staff to know where
these can be found
Think about whether you could
have handled a situation better?
What have you learnt?
Discuss situations with your
colleagues and manager. Talking
things through can help you
overcome issues, feelings and help
you progress in your work
Ask…
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Well done! You have completed this workbook. What’s next…..
An essential part of the Care Certificate is to assess, evidence and record what
you have learnt. You may be entitled to use our assessment and evidence
recording system. Your manager is responsible for supporting you with this,
observing your practice and ensuring you are competent in your workplace, with
the people you support.
Checking your knowledge, competence and practice will be a regular part of your
ongoing Continuous Professional Development.
By taking an assessment first, you may find you already have some, most, or
all of the knowledge required and you can save time by avoiding repeating
subjects and courses unnecessarily.
More information about our resources can be found at
www.CareCertificate.co.uk.
Important Copyright Note:
This workbook is provided free of charge by The Grey Matter Group to people providing health and
social care to support a blended learning approach towards learning and achieving competence. It is
subject to the following criteria:
You cannot copy, reproduce or use any part of this workbook for financial gain or as part of a training
event that you are charging for or profiting from. You cannot use this workbook to create eLearning.
You cannot copy any of the images in this workbook as they are used under a license agreement.
We strongly recommend that you use it electronically to save paper.
If you pay to (or are funded to) use our online assessment system, you are welcome to have a free
Microsoft Word version of this workbook so you can make changes, personalise it, add your
organisation’s details and logo, provided The Grey Matter Group is credited for creating the workbook
and our logo remains on each page. For more info email: [email protected].
Every effort has been made to ensure the information contained in this workbook is accurate. We
cannot guarantee completeness or accuracy for all work settings. If you download an electronic
version from our website, these will be kept updated as appropriate. We are not responsible for
keeping any versions you have previously downloaded and amended up to date.
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